Summary & Overview
HCPCS C9046: Cocaine Hydrochloride Nasal Solution (goprelto), 1 mg
HCPCS Level II code C9046 designates cocaine hydrochloride nasal solution (goprelto), 1 mg. The code captures billing for a topical nasal anesthetic and vasoconstrictor used in nasal procedures, diagnostic nasal endoscopy, or short nasal surgical interventions where topical anesthesia and hemostasis are required. Nationally, accurate coding of this agent matters for clinical documentation, controlled-substance handling, and payer coverage determinations.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for topical nasal cocaine use, common sites of service, and payer coverage landscape. The publication summarizes benchmark considerations and policy implications relevant to billing and reimbursement, including national payer practices, coding nuances for HCPCS Level II products, and documentation elements that typically intersect with coverage reviews.
This resource provides a concise reference for clinicians, billing professionals, and policy analysts seeking clarity on HCPCS Level II code C9046, explaining what the code represents, where it is commonly used, and which major payers are most often referenced in national coverage discussions. Data not available in the input for taxonomies, specific ICD-10 pairings, and related codes is noted where relevant.
Billing Code Overview
HCPCS Level II code C9046 represents cocaine hydrochloride nasal solution (goprelto), 1 mg. This billing code is used for administration of a topical nasal anesthetic/vasoconstrictor formulated as a solution containing 1 mg of cocaine hydrochloride per billing unit.
-
Service type: Topical nasal anesthetic and vasoconstrictive agent administration
-
Typical site of service: Nasal procedures and examinations in outpatient clinic, ambulatory surgery center, or emergency department settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an otolaryngology clinic or the emergency department with active anterior epistaxis or requiring topical nasal anesthesia and vasoconstriction for a diagnostic or minor procedural intervention. The clinician prepares topical C9046 (cocaine hydrochloride nasal solution, 1 mg) applied as soaked pledgets or atomized locally to the nasal mucosa to provide combined local anesthesia and potent vasoconstriction. Typical workflow: patient evaluation and history, topical decongestion/anesthesia using C9046, visualization with nasal speculum or endoscope, and then nasal packing, cautery, foreign body removal, or laceration repair as indicated. Monitoring for cardiovascular and central nervous system effects occurs during and after application. Typical site of service is outpatient otolaryngology clinic, ambulatory surgery center, or emergency department where topical nasal anesthesia/vasoconstriction is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no special modifier applies and billing requires the base HCPCS only |